Surviving Worry

With Cats, some say, one rule is true:
Don’t speak till you are spoken to.
Myself, I do not hold with that –

~T.S. Eliot from “The Ad-Dressing of Cats”

A true story I wrote 15 years ago…

Considering myself a Dr. Doolittle of sorts, always talking to the animals, I reach out to pet a stray cat sitting quietly outside our barn one evening while doing barn chores. This is a grayish fluffy cat I see around the barns every few months or so–he doesn’t put in frequent appearances and reminds me of a kitten we raised on this farm a few years back, though his markings are a bit different, so I know it is not our cat.

We have 6 cats to pet here who claim “us” as their home and family, so there is no lack of fur balls to love. There are probably that many more who hang out,  now and then, considering our farm fair game and looking for an occasional free meal. This cat just seemed to need a reassuring pat at that moment – or maybe I needed the reassurance. 

Wrong.

I found myself with a cat attached to my wrist by teeth and claws. It took a bit of an effort to shake him off and he escaped into the night. I then surveyed the damage he inflicted and immediately went to wash my wounds. They were deep punctures near my wrist joint–not good.  Lucky for me I was up to date on my tetanus booster.

By the next day the wounds were getting inflamed and quite sore. I know all too well the propensity of cat bites to get badly infected with Pasteurella multocida, a “bad actor” bacteria that can penetrate deep tissues and bone if not treated with aggressive antibiotics. After getting 6 opinions from my colleagues at clinic, all of whom stood solemnly shaking their heads at my 12 hour delay in getting medical attention,  I surrendered and called my doctor’s office. I pleaded for a “no visit” prescription as I was up to my eyeballs in my own patients, and he obliged me. I picked up the antibiotic prescription during a break, sat in the car ready to swallow the first one and then decided to wait a little longer before starting them, knowing they wallop the gut bacteria and cause pretty nasty side effects. I wanted to see if my own immune system might just be sufficient.

So the bacterial infection risk was significant and real but I was prepared to deal with it. For some reason I didn’t really think about the risk of rabies until the middle of the night when all dark and depressing thoughts seem to come real to me.

I don’t know this cat. I doubt he has an owner and it is highly unlikely he is rabies vaccinated. My own cats aren’t rabies vaccinated (and neither am I) though if I was a conscientious owner, they would be.  Yes, we have bats in our barns and woods and no, there has not been a rabid bat reported in our area in some time.

But what if this cat were potentially infected with the rabies virus but not yet showing symptoms? Now my mind started to work overtime as any good neurotic will do. Last summer a rabid kitten in North Carolina potentially exposed 10 people when it was passed around a softball tournament, no one aware it was ill until it died and was tested. Lots of people had to have rabies shots as a result.

This cat who had bitten me was long gone–there was no finding him in the vast woods and farmland surrounding us. He couldn’t be kept in observation for 10 days and watched for symptoms, nor could he be sacrificed to examine his neural tissue for signs of the virus.

I called the health department to ask what their recommendation was in a case like this. Do they recommend rabies immune globulin injection which should have been done as soon as possible after the bite? I talked with a nurse who read from a prepared script for worried people like me. 

Feral cats in our area have not been reported to have rabies nor have skunks or raccoons. Only local bats have been reported to have rabies but not recently. This cat would have had to have been bitten by a rabid bat to be rabid. This was considered a “provoked” attack as I had reached out to pet the cat. This was not a cat acting unusually other than having wrapped itself around my arm.  No, the Health Dept would not recommend rabies immune globulin in this situation but I was free to contact my own doctor to have it done at my own expense if I wished to have the series of 5 vaccination shots over the next month at a cost of about $3000. Yes, there would be a degree of uncertainty about this and I’d have to live with that uncertainty but she reassured me this was considered a very low risk incident.

I knew this was exactly what I would be told and I would have counseled any patient with the same words. Somehow it is always more personal when the risk of being wrong has such dire consequences. 

I could see the headlines “Local Doctor Dies From Rabid Cat Bite”.

This is not how I want to be remembered.

Rabies is one of the worst possible ways to die. The cases I’ve read about are among the most frightening I’ve ever seen in the medical literature. Not only is it painful and horrific but it puts family and care providers at risk as well. It also has an unpredictable incubation period of a up to a month or two, even being reported as long as a year after an exposure. What a long time to wait in uncertainty. It also has a prodrome of several days of very nonspecific symptoms of headache, fever and general malaise, like any other viral infection before the encephalitis and other bad stuff hits. I was going to think about it any time I had a little headache or chill.  This was assuredly going to be a real test of my dubious ability to stifle my tendency for 4-dimensional worries.

I decided to live with the low risk uncertainty and forego the vaccination series. It was a pragmatic decision based on the odds. My wounds slowly healed without needing antibiotics. For ten days I watched for my attacker cat whenever I went to the barn, but he didn’t put in an appearance. I put out extra food and hoped to lure him in. It would have been just be so nice to see his healthy face and not have to think about this gray cloud hanging over me for the next few months, as I wondered about every stray symptom. 

No gray kitty to be seen.

Almost a month has gone by now and he finally showed up last night.  I could have grabbed him and hugged him but I know better now. No more Dr. Doolittle.

He is perfectly fine and now so am I, cured of a terminal case of worry and hypochondria which is not nearly as deadly as rabies but can be debilitating and life shortening none the less.

From now on, I’ll be contented to just “talk to the animals” like any good Dr. Doolittle.  I don’t need to cuddle them.

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Through Many Dangers, Toils, and Snares…

Eighteen years ago this week, a college student was brought to our university health clinic by his concerned roommates, as he seemed to be getting sicker with that winter’s seasonal influenza. His family gave permission for his story to be told.

Nothing was helping.  Everything had been tried for a week of the most intensive critical care possible.  A twenty year old man – completely healthy only two weeks previously – was dying and nothing could stop it.

The battle against a sudden MRSA (Methicillin Resistant Staph Aureus) pneumonia precipitated by a routine seasonal influenza infection had been lost. Despite aggressive hemodynamic, antibiotic, antiviral and ventilator management, he was becoming more hypoxic and his renal function was deteriorating.  He was no longer responsive to stimuli.

The intensivist looked weary and defeated. The nurses were staring at their laps, unable to look up, their eyes tearing. The hospital chaplain reached out to hold this young man’s mother’s shaking hands.

After a week of heroic effort and treatment, there was now clarity about the next step.

Two hours later, a group gathered in the waiting room outside the ICU doors. The average age was about 21; they assisted each other in tying on the gowns over their clothing, distributed gloves and masks. Together, holding each other up, they waited for the signal to gather in his room after the ventilator had been removed and he was breathing without assistance. They entered and gathered around his bed.

He was ravaged by this sudden illness, his strong body beaten and giving up. His breathing was now ragged and irregular, sedation preventing response but not necessarily preventing awareness. He was surrounded by silence as each individual who had known and loved him struggled with the knowledge that this was the final goodbye.

His father approached the head of the bed and put his hands on his boy’s forehead and cheek.  He held this young man’s face tenderly, bowing in silent prayer and then murmuring words of comfort:

It is okay to let go. It is okay to leave us now.
We will see you again. We’ll meet again.
We’ll know where you will be.

His mother stood alongside, rubbing her son’s arms, gazing into his face as he slowly slowly slipped away. His father began humming, indistinguishable notes initially, just low sounds coming from a deep well of anguish and loss.

As the son’s breaths spaced farther apart, his dad’s hummed song became recognizable as the hymn of praise by John Newton, Amazing Grace.  The words started to form around the notes. At first his dad was singing alone, giving this gift to his son as he passed, and then his mom joined in as well. His sisters wept. His friends didn’t know all the words but tried to sing through their tears. The chaplain helped when we stumbled, not knowing if we were getting it right, not ever having done anything like this before.

Amazing Grace, how sweet the sound,
That saved a wretch like me.
I once was lost but now am found,
Was blind, but now I see.

Through many dangers, toils and snares
I have already come;
‘Tis Grace that brought me safe thus far
and Grace will lead me home.

Yea, when this flesh and heart shall fail,
And mortal life shall cease,
I shall possess within the veil,
A life of joy and peace.

When we’ve been here ten thousand years
Bright shining as the sun.
We’ve no less days to sing God’s praise
Than when we’ve first begun.

And he left us.

His mom hugged each sobbing person there–the young friends, the nurses, the doctors humbled by powerful pathogens. She thanked each one for being present for his death, for their vigil kept through the week in the hospital as his flesh and heart had failed.

This young man, now lost to this mortal life, had profoundly touched people in a way he could not have ever predicted or expected. His parents’ grief, so gracious and giving to the young people who had never confronted death before, remains unforgettable.

This was their sacred gift to their son – so Grace could lead him home.

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Strung on the Necklace of Days

It is a dark fall day.
The earth is slightly damp with rain.
I hear a jay.
The cry is blue.
I have found you in the story again.
Is there another word for “divine”?
I need a song that will keep sky open in my mind.
If I think behind me, I might break.
If I think forward, I lose now. 
Forever will be a day like this
Strung perfectly on the necklace of days.
Slightly overcast
Yellow leaves
Your jacket hanging in the hallway
Next to mine.

~Joy Harjo “Fall Song”

bluejay photo by Josh Scholten

November 22 always has a sadness about it for those of us who listened to the tragic news reports and experienced the aftermath of that day…

In the seemingly endless,
sometimes bleak string of fall days,
each one differing little from the one before
and the one that comes after,
there is linkage to winter on its way,
inescapable and unrelenting.

If I were to try to stop time now,
hold tight to a particular moment,
this necklace of days would break and scatter,
as a sustaining connection depends
on preserving what was before,
breathing deeply of what is now,
and praying for what is to come.

Each moment
never in isolation from those surrounding it.

(this article about JFK’s granddaughter’s terminal diagnosis was particularly poignant for me this morning)

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The Glow of Ripeness

Love means to learn to look at yourself
The way one looks at distant things
For you are only one thing among many.
And whoever sees that way heals his heart,
Without knowing it, from various ills—
A bird and a tree say to him: Friend.

Then he wants to use himself and things
So that they stand in the glow of ripeness.
It doesn’t matter whether he knows what he serves:
Who serves best doesn’t always understand.
~Czeslaw Milosz “Love” from New and Collected Poems: 1931-2001

Let him kneel down, lower his face to the grass,
And look at light reflected by the ground.
There he will find everything we have lost…
~Czeslaw Milosz from “The Sun”

It’s not easy to subdue the needy ego and let the life-giving soul take control, even though doing so saves us grief and serves the world well. So if you see me on the street one day, quietly muttering, “Only one thing among many, only one thing among many…,” you’ll know I’m still working on it, or it’s still working on me.
~Parker Palmer “The Big Question: Does My Life Have Meaning?”

It is always tempting to be self-absorbed; since my heart stent placement nearly 8 months ago, I tend to analyze every sensation in my chest, fuss over how many steps I take daily, and get discouraged when the scale doesn’t register the sacrifices I think I’m making in my diet.

In other words, in my efforts to heal my physically-broken heart, I become the center of my attention, rather than just one among many things in the days/months/years I have left. I need to look at myself from a distance rather than under a microscope.

It is a skewed and futile perspective, seeking meaning and purpose in life by navel gazing.

Instead, I should be concentrating on the ripeness of each day. I’ve been given a second chance to recalibrate my journey through the time I have left, focusing outward, gazing at the wonders around me, sometimes getting down on my knees.

I don’t fully understand how I might serve others by what I share here online, or what I do in my local community with my hands and feet. I now know not to miss the moments basking in the glow of loving those around me, including you friends I may never meet on this side of the veil.

May you glow in ripeness as well.

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Another Mammogram Day

“They’re benign,” the radiologist says,
pointing to specks on the x ray
that look like dust motes
stopped cold in their dance.
His words take my spine like flame.
I suddenly love
the radiologist, the nurse, my paper gown,
the vapid print on the dressing room wall.
I pull on my radiant clothes.
I step out into the Hanging Gardens, the Taj Mahal,
the Niagara Falls of the parking lot.

~Jo McDougall, “Mammogram” from In the Home of the Famous Dead: Collected Poems

Outside the house the wind is howling
and the trees are creaking horribly.
This is an old story
with its old beginning,
as I lay me down to sleep.
But when I wake up, sunlight
has taken over the room.
You have already made the coffee
and the radio brings us music
from a confident age. In the paper
bad news is set in distant places.
Whatever was bound to happen
in my story did not happen.
But I know there are rules that cannot be broken.
Perhaps a name was changed.
A small mistake. Perhaps
a woman I do not know
is facing the day with the heavy heart
that, by all rights, should have been mine.
~Lisel Mueller “In November”

It does not escape me,
especially on call-back mammogram days
when I’m asked to return for a
“closer look” at something that
wasn’t there before.

which turns out to be a 1 cm. nonspecific solid something,
maybe getting smaller over the past ten days.

Maybe a bruise. Maybe not.
Check again in a month.
A brief reprieve that some in the
dressing cubicles around me
don’t get.

I wake every day knowing:
an earthquake happens somewhere else,
a war is leaving people homeless and lifeless,
a tornado levels a town,
a drunk driver destroys a family,
a fire leaves a house in ashes,
a famine causes children to starve,
a flood ravages a town,
a devastating diagnosis darkens
someone’s remaining days.

No mistake has been made,
yet I wake knowing recently
it was my turn to hear bad news,
my heart was heavy,
yet it
still beats,
still breaks,
still bleeds,
still believes
in the radiance of each new day I’m given.
I was reminded again today.

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Where We Could Not Reach

My father would lift me
to the ceiling in his big hands
and ask, 
How’s the weather up there?
And it was good, the weather
of being in his hands, his breath
of scotch and cigarettes, his face
smiling from the world below.
O daddy, was the lullaby I sang
back down to him as he stood on earth,
my great, white-shirted father, home
from work, his gold wristwatch
and wedding band gleaming
as he held me above him
for as long as he could,
before his strength failed
down there in the world I find myself
standing in tonight, my little boy
looking down from his flight
below the ceiling, cradled in my hands,
his eyes wide and already staring
into the distance beyond the man
asking him again and again,
How’s the weather up there?
~George Bilgere “Weather”.

It was hard work, dying, harder
than anything he’d ever done.

Whatever brutal, bruising, back-
breaking chore he’d forced himself

to endure—it was nothing
compared to this. And it took

so long. When would the job
be over? Who would call him

home for supper? And it was
hard for us (his children)—

all of our lives we’d heard
my mother telling us to go out,

help your father, but this
was work we could not do.

He was way out beyond us,
in a field we could not reach.

~Joyce Sutphen “My Father, Dying”

Deep in one of our closets is an old film reel of me about 16 months old sitting securely held by my father on his shoulders. I am bursting out with giggles as he repeatedly bends forward, dipping his head and shoulders down. I tip forward, looking like I am about to fall off, and when he stands back up straight, my mouth becomes a large O and I can almost remember the tummy tickle I feel. I want him to do it again and again, taking me to the edge of falling off and then bringing me back from the brink.

My father was a tall man, so being swept up onto his shoulders felt a bit like I was touching heaven.

It was as he lay dying 30 years ago this summer that I realized again how tall he was — his feet kept hitting the foot panel of the hospital bed my mother had requested for their home. We cushioned his feet with padding so he wouldn’t get abrasions even though he would never stand on them again, no longer towering over us.

His helplessness in dying was startling – this man who could build anything and accomplish whatever he set his mind to was unable to subdue his cancer. Our father, who was so self-sufficient he rarely asked for help, did not know how to ask for help now.

So we did what we could when we could tell he was uncomfortable, which wasn’t often. He didn’t say much, even though there was much we could have been saying. We didn’t reminisce. We didn’t laugh and joke together. We just were there, taking shifts catching naps on the couch so we could be available if he called out, which he never did.

This man:
who had grown up dirt poor,
fought hard with his alcoholic father
left abruptly to go to college – the first in his family –
then called to war for three years in the South Pacific.

This man:
who had raised a family on a small farm while he was a teacher,
then a supervisor, then a desk worker.

This man:
who left our family to marry another woman
but returned after a decade to ask forgiveness.

This man:
who died in a house he had built completely himself,
without assistance, from the ground up.

He didn’t need our help – he who had held tightly to us and brought us back from the brink when we went too far – he had been on the brink himself and was rescued, coming back humbled.

No question the weather is fine for him up there. I have no doubt.

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Strung With Care

In none of her other ages had she noted
her age or its burden and bounty of expectations.
The future was as flexible as the past,
and, in between, moments like unstrung pearls
strewn across velvet grieved and gladdened her
and always astonished her with their perfection.
There was no nothingness: there was only being.


Slowly she wakes from what had seemed a dream
to realize that this is her final age—
of indeterminate length and quality.
Things are ending, or have ended, or will end.
The pearls are strung with care, it is quite clear.
There is no nothingness—but she can almost,
some days, picture the world without her in it.

~Jane Greer “In none of her other ages”
(Jane died after a short illness last week at the age of 72)

I have always been well aware
we each arrive here with an expiration date
hidden from view.

We may live for decades assuming
the circled length of our own string of pearls
will continue indefinitely
with the latch closed and tight.

A few months ago,
my clasp opened unexpectedly,
my finite days of carefully strung pearls
threatening to spill, forever lost to me.

I realized things could end
without any hugged goodbyes.

Later, having been emergently restrung,
at least for the time being,
the look in my eyes
prompted the surgeon to say
“now you can live out your full life span.”

What I wanted to ask him
but couldn’t:
“and just how long might that be?”
knowing he had no true reassurance
for something only God can promise:

There is no nothingness.

By grace and a surgeon’s skill,
I gained nearly six months of pearls.
I’m still here, looking back
at the carefully strung
hours and days and weeks
behind and before me.

Right now I remain clasped tight,
hugging and held secure,
though one day I know
it will be time
to let go.

There we shall rest and we shall see;
we shall see and we shall love;
we shall love and we shall praise.
Behold what shall be in the end and shall not end.
~Augustine of Hippo from The City of God, Bk. XXII, Chap. 30

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The Bees of the Invisible

Let us go forward quietly,
forever making for the light,
and lifting up our hearts in the knowledge
that we are as others are
(and that others are as we are),
and that it is right to love one another
in the best possible way –
believing all things,
hoping for all things,
and enduring all things. 
~Vincent Van Gogh from a Letter to Theo Van Gogh – 3 April 1878

I have lived so long
On the cold hills alone . . .
I loved the rock
And the lean pine trees,
Hated the life in the turfy meadow,
Hated the heavy, sensuous bees.
I have lived so long
Under the high monotony of starry skies,
I am so cased about
With the clean wind and the cold nights,
People will not let me in
To their warm gardens
Full of bees.

~Janet Loxley Lewis “Austerity”


Everywhere transience is plunging into the depths of Being.
It is our task to imprint this temporary, perishable earth
into ourselves, so deeply, so painfully and passionately,
that its essence can rise again, invisible, inside of us.
We are the bees of the invisible.
We wildly collect the honey of the visible,
to store it in the great golden hive of the invisible.
~Rainier Maria Rilke in a letter to his friend Witold Hulewicz, 1925

I am convinced,
reading the news,
too many people are forced to survive
in a world cold and cruel,
without warmth or safety,
too many empty stomachs,
no healing hands for injury or disease.

Our country was trying to help
up until the last few months
when so much has been pulled away.

No longer are we, the helper bees, sent to the invisible,
bringing tangible hope and light, food and meds,
to those who have so little.

No longer do we bring collected honey
to the suffering, the ill, the poor and
invisible who share this planet.

Oh Lord, turn us away from such austerity.
Let us not forget how to share
the humming riches of Your warm garden.

AI image created for this post

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As the Light Left…

The second before the sun went out we saw a wall of dark shadow come speeding at us. We no sooner saw it than it was upon us, like thunder. It roared up the valley. It slammed our hill and knocked us out. It was the monstrous swift shadow cone of the moon. I have since read that this wave of shadow moves 1,800 miles an hour. Language can give no sense of this sort of speed—1,800 miles an hour. It was 195 miles wide. No end was in sight—you saw only the edge. It rolled at you across the land at 1,800 miles an hour, hauling darkness like plague behind it. Seeing it, and knowing it was coming straight for you, was like feeling a slug of anesthetic shoot up your arm. If you think very fast, you may have time to think, “Soon it will hit my brain.” You can feel the deadness race up your arm; you can feel the appalling, inhuman speed of your own blood. We saw the wall of shadow coming, and screamed before it hit.

This was the universe about which we have read so much and never before felt: the universe as a clockwork of loose spheres flung at stupefying, unauthorized speeds. How could anything moving so fast not crash, not veer from its orbit amok like a car out of control on a turn?

Less than two minutes later, when the sun emerged, the trailing edge of the shadow cone sped away. It coursed down our hill and raced eastward over the plain, faster than the eye could believe; it swept over the plain and dropped over the planet’s rim in a twinkling. It had clobbered us, and now it roared away. We blinked in the light. It was as though an enormous, loping god in the sky had reached down and slapped the Earth’s face.

When the sun appeared as a blinding bead on the ring’s side, the eclipse was over. The black lens cover appeared again, back-lighted, and slid away. At once the yellow light made the sky blue again; the black lid dissolved and vanished. The real world began there. I remember now: We all hurried away.

We never looked back. It was a general vamoose … but enough is enough. One turns at last even from glory itself with a sigh of relief. From the depths of mystery, and even from the heights of splendor, we bounce back and hurry for the latitudes of home.
~Annie Dillard from her essay  “Total Eclipse” in The Atlantic about the February 1979 eclipse in Washington State

sundown

From my six week psychiatric inpatient rotation at a Veteran’s Hospital—late winter 1979

Sixty eight year old male catatonic with depression

He lies still, so very still under the sheet, eyes closed; the only clue that he is living is the slight rise and fall of his chest.  His face is skull- like framing his sunken eyes, his facial bones standing out like shelves above the hollows of his cheeks, his hands lie skeletal next to an emaciated body.  He looks as if he is dying of cancer but without the smell of decay.  He rouses a little when touched, not at all when spoken to.  His eyes open only when it is demanded of him, and he focuses with difficulty.  His tongue is thick and dry, his whispered words mostly indecipherable, heard best by bending down low to the bed, holding an ear almost to his cracked lips.

He has stopped feeding himself, not caring about hunger pangs, not salivating at enticing aromas or enjoying the taste of beloved coffee.  His meals are fed through a beige rubber tube running through a hole in his abdominal wall emptying into his stomach, dripping a yeasty smelling concoction of thick white fluid full of calories.  He ‘eats’ without tasting and without caring. His sedating antidepressant pills are crushed, pushed through the tube, oozing into him, deepening his sleep, but are designed to eventually wake him from his deep debilitating melancholy.

After two weeks of treatment and nutrition, his cheeks start to fill in, and his eyes are closed less often.  He watches people as they move around the room and he responds a little faster to questions and starts to look us in the eye.   He asks for coffee, then pudding and eventually he asks for steak.  By the third week he is sitting up in a chair, reading the paper.

After a month, he walks out of the hospital, 15 pounds heavier than when he was wheeled in.  His lips, no longer dried and cracking, have begun to smile again.

Thirty two year old male rescued by the Coast Guard at 3 AM in the middle of the bay

As he shouts, his eyes dart, his voice breaks, his head tosses back and forth, his back arches and then collapses as he lies tethered to the gurney with leather restraints.  He writhes constantly, his arm and leg muscles flexing against the wrist and ankle bracelets.

“The angels are waiting!!  They’re calling me to come!! Can’t you hear them?  What’s wrong with you?  I’m Jesus Christ, King of Kings!!  Lord of Lords!!  If you don’t let me return to them, I can’t stop the destruction!”

He finally falls asleep by mid-morning after being given enough antipsychotic medication to kill a horse. He sleeps uninterrupted for nine hours. Then suddenly his eyes fly open, and he looks startled.

He glares at me.  “Where am I? How did I get here?”

“You are hospitalized in the VA psych ward after being picked up by the Coast Guard after swimming out into the bay in the middle of the night. You said you were trying to reach the angels.”

He turns his head away, his fists relaxing in the restraints, and begins to weep uncontrollably, the tears streaming down his face.

“Forgive them, Father, for they know not what they do.”

Twenty two year old male with auditory and visual hallucinations

He seems serene, much more comfortable in his own skin when compared to the others on the ward. Walking up and down the long hallways alone, he is always in deep conversation. He takes turns talking, but more often is listening, nodding,  almost conspiratorial.

During a one-on-one session, he looks at me briefly, but his attention continues to be diverted, first watching an invisible something or someone enter the room, move from the door to the middle of the room, until finally, his eyes lock on an empty chair to my left. I ask him what he sees next to me.

“Jesus wants you to know He loves you.”

It takes all my will power not to turn and look at the empty chair.

**********************************************************************

Fifty four year old male with chronic paranoid schizophrenia

He has been disabled with psychiatric illness for thirty years, having his first psychotic break while serving in World War II.   His only time living outside of institutions has been spent sharing a home with his mother who is now in her eighties.  This hospitalization was precipitated by his increasing delusion that his mother is the devil and the voices in his head commanded that he kill her. He had become increasingly agitated and angry, had threatened her with a knife, so she called the police, pleading with them not to arrest him, but to bring him to the hospital for medication adjustment.

His eyes have taken on the glassy staring look of the overmedicated psychotic, and he sits in the day room much of the day sleeping in a chair, drool dripping off his lower lip.  When awake he answers questions calmly and appropriately with no indication of the delusions or agitation that led to his hospitalization.  His mother visits him almost daily, bringing him his favorite foods from home which he gratefully accepts and eats with enthusiasm.  By the second week, he is able to take short passes to go home with her, spending a lunch time together and then returning to the ward for dinner and overnight. By the third week, he is ready for discharge, his mother gratefully thanking the doctors for the improvement she sees in her son.  I watch them walk down the long hallway together to be let through the locked doors to freedom.

Two days later, a headline in the local paper:

“Veteran Beheads Elderly Mother”

Forty five year old male — bipolar disorder with psychotic features

He has been on the ward for almost a year, his unique high pitched laughter heard easily from behind closed doors,  his eyes intense in his effort to conceal his struggles.  Trying to follow his line of thinking is challenging, as he talks quickly, with frequent brilliant off topic tangents, and at times he lapses into a “word salad” of almost nonsensical sentences.  Every day as I meet with him I become more confused about what is going on with him, and am unclear what is expected of me in my interactions with him.  He senses my discomfort and tries to ease my concern.

“Listen, this is not your problem to fix but I’m bipolar and regularly hear command voices and have intrusive thoughts.  My medication keeps me under good control.  But just tell me if you think I’m not making sense because I don’t always recognize it in myself.”

During my rotation, his tenuous tether to sanity is close to breaking.  He starts to listen more intently to the voices in his head, becoming frightened and anxious, often mumbling and murmuring under his breath as he goes about his day.

On a particular morning, all the patients are more anxious than usual, pacing and wringing their hands as the light outdoors slowly fades, with noon being transformed to an oddly shadowy dusk. The street lights turn on automatically and cars are driving with headlights shining.  We stand at the windows in the hospital, watching the city become dark as night in the middle of the day.  The unstable patients are sure the world is ending and extra doses of medication are dispensed as needed while the light slowly returns to the streets outside.  Within an hour the sunlight is back, and all the patients are napping soundly.

The psychiatrist locks himself in his office and doesn’t respond to knocks on the door or calls on his desk phone.

Stressed by the recent homicide by one of his discharged patients, and identifying with his patients due to his own mental illness, he is overwhelmed by the eclipse. The nurses call the hospital administrator who comes to the ward with two security guards. They unlock the door and lead the psychiatrist off the ward. We watch him leave, knowing he won’t be back.

It is as if the light had left and only his shadow remains.

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Lyrics:
Measure me, sky!
    Tell me I reach by a song
Nearer the stars;
    I have been little so long.

Weigh me, high wind!
    What will your wild scales record?
Profit of pain,
    Joy by the weight of a word.

Horizon, reach out!
    Catch at my hands, stretch me taut,
Rim of the world:
    Widen my eyes by a thought.

Sky, be my depth,
    Wind, be my width and my height,
World, my heart’s span;
    Loveliness, wings for my flight.
~Leonora Speyer

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Where You Go, I Will Go: My Heart Caught Off Guard

And some time make the time to drive out west
Into County Clare, along the Flaggy Shore,
In September or October, when the wind
And the light are working off each other
So that the ocean on one side is wild
With foam and glitter, and inland among stones
The surface of a slate-grey lake is lit
By the earthed lightning of a flock of swans,
Their feathers roughed and ruffling, white on white,
Their fully grown headstrong-looking heads
Tucked or cresting or busy underwater.
Useless to think you’ll park and capture it
More thoroughly. You are neither here nor there,
A hurry through which known and strange things pass
As big soft buffetings come at the car sideways
And catch the heart off guard and blow it open.
~Seamus Heaney “Postscript” from The Spirit Level

…they can hardly contain their happiness
That we have come.


They bow shyly as wet swans. They love each other.

There is no loneliness like theirs.

Suddenly I realize
That if I stepped out of my body I would break
Into blossom.
~James Wright from “The Blessing”

I have looked upon those brilliant creatures,   
And now my heart is sore.
All’s changed since I, hearing at twilight,   
The first time on this shore,
The bell-beat of their wings above my head,   
Trod with a lighter tread.
~William Butler Yeats from “The Wild Swans at Coole”

‘Tis strange that death
should sing.
I am the cygnet to this pale faint swan,
Who chants a doleful hymn to his own death,
And from the organ-pipe of frailty sings
His soul and body to their lasting rest.
~William Shakespeare from “King John”

Walking outside before the sun was up on a recent rainy morning,  I heard overhead the swishing hush of wings in flight and the trumpeter swans’ doleful call as dozens passed above me in a long meandering line against the early dawn grayness.

The swan flocks predictably arrive here in late autumn to eat their fill, feasting in the harvested cornfields surrounding our farm, their bright white plumage a stark contrast to the dulling muddy soil. Usually, they stick around until spring, as they lift their long graceful necks and fan out their wings to be picked up the wind, leaving us behind and beneath, moving on to their next feeding and breeding grounds.

These incredible creatures bring such joy with their annual arrival, while their leave-taking reminds me, once again, nothing on earth can last.

My heart recently caught off guard still beats. God’s love heals our earthly hearts.

“‘Tis strange that death should sing…

I give myself over to their beauty, and walk with lighter tread, singing a new song: I am grateful my heart someday will soar beyond this soil.

 So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal.
2 Corinthians 4: 16-18

This year’s Lenten theme:

…where you go I will go…
Ruth 1:16

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